A pivotal moment of my life came when I was a new mother suffering from postpartum depression/anxiety: I hit the proverbial wall and had finally gotten treatment. I was laying on a futon on my living room floor with my dear friend Gwen holding my hand. It was the first time in 3 weeks I would sleep. That night, due Gwen's support, I slept life back into myself. It was the kindest thing anyone had ever done for me. I wasn't alone. I wasn't to blame. With help, I would be well again. My darkest days were over. The profound gift given by my friend changed the trajectory of my life. As with many of us who have been through it with postpartum depression/anxiety, helping others became a passion and I discovered Postpartum Support International (PSI):

PSI is a non-profit organization whose mission is to promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide. It is the vision of PSI that every woman and family worldwide will have access to information, social support, and informed professional care to deal with mental health issues related to childbearing. PSI promotes this vision through advocacy and collaboration, and by educating and training the professional community and the public. 1-800-944-4PPD

In October, it was my profound honor to meet the founder of PSI, Jane Honikman, M.S. A survivor of postpartum depression, and a tireless advocate for women's rights, Jane founded PSI in 1987 after twenty years of advocacy in civil rights, feminism, and natural childbirth movements. Jane ran PSI for nearly two decades from her home, with the help of her husband, Terry. To this day, Jane dedicates herself to the rights of all women, and families, to informed health care, treatment, and the ending of stigma regarding maternal mental illness. Not surprisingly, Jane was delighted to do an interview with me for Giving Birth With Confidence. My questions were designed to get Jane's advice for women today in how they can give birth with confidence, empower themselves with the tools to take care of their emotional health, and address the stigma of motherhood and mental health. To read more of my interview with Jane regarding how professionals can address perinatal mental health please visit: www.scienceandsensibility.org

How can a woman who may be at risk for depression give birth with confidence today?Jane: Women today can give birth with confidence by being open and honest with themselves, their family members, and their healthcare providers about their emotional health. We know that mental illness runs in families. We also know that a woman's personal mental health history is vital to her pregnancy, birth and postpartum experience. But the truth is we cannot predict the future. I actually prefer to assume that everyone is at risk. Women need to take into account their partner's emotional history as well. This is not a woman's issue. It is important to lower one's expectations about parenthood and to prepare a nurturing home environment. Everyone who surrounds the pregnant woman is part of the picture of having a happy and healthy outcome.

How would you advise pregnant and breastfeeding women to fight stigma today?Jane: The fight to end stigma begins within one's own heart. A woman and her partner need to be frank, open, and honest about their own family and personal history of mental illness. My advice is to learn to talk openly about past disappointments, losses, and traumas. It begins with conversations among one's friends over fears about being pregnant, giving birth, and bringing a baby home. Honesty is disarming. It should set the stage for dialogue. This continues with her health care providers. Whenever I get a chance I speak openly about my own journey through depression and anxiety, it includes telling the truth about my first pregnancy and my story of placing our first born in an adoptive home. It took me twenty five years to find inner peace because I kept that secret. It takes courage to fight stigma.

What do you see as the main causes of stigma regarding mental health for pregnant and breastfeeding women today?Jane: The causes of stigma include ignorance and denial about the importance of emotional wellbeing of childbearing women. On the community, national and international levels this ignorance is being eliminated through educational awareness campaigns. There is no excuse not be educated about the range of emotional reactions during the perinatal period. Denial is a personal issue and more difficult to confront. It is impossible to know how one's expectations of motherhood will be met. The mythology that surrounds parenthood is another huge barrier. Taboos need to be openly discussed. Often there are conflicts between the woman and her partner. These need to be discussed. It is difficult to parent alone. Family members should participate in supporting the new family. It is important to have frank and honest conversations about opinions and expectations within the extended family unit during pregnancy and following the arrival of the baby.

Have stigmas changed over time?Jane: Yes, we have overcome major barriers in the fight against stigma. Awareness has increased tremendously since I first got involved nearly forty years ago. The availability of accurate information, resources and referral networks is responsible for these changes. The media has been our movement's best friend. For example, there are now free materials from the federal government, healthy start programs include maternal mental health curriculums, and states have active coalitions. Insurance companies have eliminated barriers to receiving and providing mental health coverage. All of the major medical organizations have stepped forward offering educational seminars to their members. The courts now consider mental health history when they encounter a crime. The internet has played an enormous role. Postpartum Support International's website www.postpartum.net has been a leader in this progress.

How are support groups helpful to a woman with depression or anxiety?Jane: The role of a support group is to provide a confidential and safe environment for women to share their concerns and experiences. They are surrounded by nonjudgmental listeners. In a support group you're physically not alone even if your emotional state is fragile. It is the best possible therapy even when you are not depressed or anxious. In one word, it is about friendship. I meet weekly with my girlfriends for breakfast and have done so for nearly thirty years. It is not an official support group but it works like one. During my darkest days I always knew I could go and find comfort.

What is the worst advice you ever received?Jane: It wasn't bad advice, but rather the absence of any. The era in which I was raised gave me strength to help others but not to take care of myself. I kept silent about the most painful part of own experience.

What is the best advice you ever received?Jane: The best advice I received was to get help for myself. Fighting my own denial was a long, slow, and painful process. I am a good example of how deeply stigma reaches into one's own soul. Even though I had been helping thousands of women and their families I had not confronted my own demon. I knew my options but I wasn't ready.To read more about Jane's personal story: http://janehonikman.com/my-diary/

What have been the highlights of your advocacy work in the field of postpartum depression?Jane: The remarkable growth of Postpartum Support International (PSI) www.postpartum.net makes me smile. We started with a few members thinly spread throughout the world. I operated the PSI office fulltime for seventeen years in my home. During those years I listened to thousands women and their families tell me their stories. My greatest joy is to have someone I have supported, tell me they're well and now ready to help others. I have traveled the world learning about maternal mental health at conferences and sharing my vision. I have written two books about achieving this goal. It has been a privilege to participate in mental health efforts by local, state, and federal governments. I love to network, linking individuals with resources, and helping to create resources for referrals. It was a highlight in May 2010 to hear the President of American College of Obstetrics and Gynecology Congress speak about his initiative on postpartum depression. On a personal, level I've been fortunate to provide postpartum support to my own children. I feel very blessed.

Where is the future of maternal mental health advocacy? Where are you focusing your efforts next?Jane: The future of maternal mental health advocacy is with peer support, grassroots, community-based, local efforts. Consumers, professionals, and organizations must collaborate to develop postpartum parent support networks in every community. Pregnant and postpartum families need information, resources and a way to meet. They deserve to have friendships that will last a life time. My current focus is to help spread the word about the organization I helped to establish in 1977. Postpartum Education for Parents (PEP) www.sbpep.org is a model that has not been replicated. For over thirty years PEP volunteers have been offering free nonjudgmental emotional support to new parents. I want to see PEP spread around the world. It is an elegant yet simple program rooted in the belief that every new parent deserves emotional support. In the future my focus will be to travel the world inspiring others to join in the effort to make maternal mental health the priority it needs to be in all societies.

Jane Honikman embodies an unwavering, fierce determination to help women suffering from depression/anxiety know that they are not alone. Every woman deserves to know universal messages support not only to get through her darkest days, but to avoid dark days altogether by addressing stigma head-on. If you have questions about depression/anxiety in pregnancy or postpartum, please visit www.postpartum.net; or call the PSI Warm-line at: 1-800-944-4PPD.

You are not alone. You are not to blame. With help, you will be well.

I would like to extend my gratitude to Jane Honikman, M.S., for her contribution to this article, and for her steadfast commitment to women everywhere. Jane&I will pass my heart to you any day. Also, thank you to both Cara Terreri, and Kimmelin Hull for giving me the opportunity to write for their sites, and to Lamaze International for their courage to go where no other birth organization has gone before: maternal mental health.

Jane Honikman, M.S.Jane Honikman, M.S., is a Parent Support Consultant/ Postpartum Specialist from Santa Barbara, California. In 1977, she co-founded Postpartum Education for Parents (PEP), and became the Executive Director of the Santa Barbara Birth Resource Center in 1984. She founded Postpartum Support International (PSI) in 1987 as a result of hosting the first conference on Women's Mental Health Following Childbirth held in Santa Barbara. She was PSI's first President and operated the organization from her home until 2004. Jane has authored many articles and educational materials on postpartum issues and how to start a support group including her books Step by Step (2000) and I'm Listening (2002). She developed a website resource www.janehonikman.com and continues to lecture internationally on the role of social support and the emotional health of families.